Provider Demographics
NPI:1417246398
Name:CASTILLO, AKSONIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AKSONIN
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2586 GLEN HAIG WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2548
Mailing Address - Country:US
Mailing Address - Phone:408-592-8428
Mailing Address - Fax:
Practice Address - Street 1:3118 STORY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3815
Practice Address - Country:US
Practice Address - Phone:408-254-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist